Child Abuse and Neglect

• Conceived out of wedlock
• Special child (premature, physical handicap, chronic illness, learning problems)
• Adolescent striving for autonomy

• Bruises (90% of cases)
• Fractures
• Head and internal injuries
• Burns (10% of cases)

• Critical is pattern and distribution (location; hidden by clothing)
• Indicative of Abuse:
• Those prior to becoming ambulatory
• Those on various parts of body
• Back of legs, upper arms and chest, neck, head, eyes, genitals
• Areas covered with clothing
• Clear pattern (palm print, buckle print, etc.)
• Color variation (no age on bruises)
• Adult bite marks
• Choke marks, pinch or grab marks (indicative of shaking)
• Nail scratches

• Strong indicator of abuse inchildren under 1 year of age
• Skull, nose, facial structure
• Various states healing
• Multiple or spiral fracture

• Mostly discovered by radiologists
• Skull factures
• Subdural hematoma- blood in the brain
• Retinal detachment, hemorrhages
• Black eyes (both are especially susupicious)
• Abdominal injuries

• Cigarette (not accidental on abdomen, genitals, bottom of feet, inaccessible spots)
• Tap water (most common)
• -"Gloved hands" or "socked" feet
• -Patterned (grill, iron, etc)
• Infected burns, indicating delay in seeking treatment

• Appear on face, lips, mouth, torso, back, buttocks, thighs
• Various stages of healing
• Clustered, forming rectangular patterns, reflecting shape of article used to inflict harm such as electrical cord or belt buckle
• Appear on several different surface areas
• Regularly appear after absence, weekend or vacation

• Unresponsive to environment
• Developmental lags
• Impaired capacity to enjoy life
• Enuresis (unable to control bladder)
• Encopresis (unable to control waste)
• Temper tantrums
• Low self-esteem
• Withdrawal
• Passive watchfulness
• Verbal inhibition
• Regression
• Fearful of failure
• Poor peer relationships
• Running away
• Depression

• Feels deserving of punishment
• Appears wary of adult contact
• Expresses apprehension when other children cry
• Expresses behavioral extremes from withdrawal to aggressiveness and/or hyperactivity
• Appears frightened of parents- afriad to go home
• Reports injury by parents
• Expresses vacant or frozen stare, listless and detached
• Lies very still while surveying surrounding (infant)
• Responds to questions in monosyllables
• Expresses inappropriate or precocious maturity
• Maintains only superficial relationships
• Expresses manipulative behavior to get attention
• Indsicriminately seeks affection
• Expresses poor self-concept
• Expresses over-compliance
• Acts consistently irritable
• Exhibits chronic ailments, stomachaches, vomiting, etc.

• Getting needs met
• Separating feelings from actions
• Determining limits of responsibilty
• Making decisions
• Delaying gratification

• Psychopathological Categories (Primary cause resides within parent)
• -Psychodynamic
• -Mental Illness
• -Character-Trait
• Interactional Categories
• -Martin
• -Zimrin
• -Family-structure model
• Environmental Sociological Cultural (stresses in society are primary cause of abuse)
• -Environment Stress Model
• -Social Learning Model
• -Social-Psychological Model
• -Pscyhosocial Systems Model

• Disturbance in nurturing relationship between parent and child
• Parent has potential to abuse based on his/her reading
• Role reversal

• Underlying cause of abuse
• Borderline, bipolar

• Traits of Abusive Parent
• -Self-centered
• -Impulsive
• -Rigid
• -Hostile
• -Dependent/Passive

Child perceived by parent as abnormal or different and becomes target of abuse

• "Encounter Theory"
• Traits, characteristics of parents interact with that of children in such a way that abuse occurs)

Dysfunctionl family pattterns (severe enmeshment or scapegoating)

• Poverty
• Unemployment
• Poor education, etc

• Emphasizes parental inadequacy
• Not learned effective, nonharmful discipline methods
• Ignorant of child development
• Unready for parenthood and become easily frustrated

• Frustration and Stress
• Stress + Individual Pathology = Abusive Episode

• Dysfunctional family patterns
• Parents have unmet needs which children are expected to meet
• Environmental stressors

• Medical
• Safety
• Educational
• Physical
• Emotional

Most likely to come to the attention of medical practitioners

• Non-compliance with recommended care
• Delay or failure in getting health care
• Nonorganic Failure to Thrive
• Drug exposed newborns
• Obesity?

• Refusal of medical interventions for religious reasons
• Refusal of childhood immunizations due to erroneous beliefs that they are dangerous
• Refusal to sign forms for necessary and perhaps life-saving interventions
• Embarking on bizarre diets that lead to vitamen deficiency and anemia
• Refusal of proven medical treatment in favor of unproven, unorthodox treatments

• Compliance is "the extent to which a patient's behavior coincides with the clinical prescription
• Short-term medications
• Preventive Regimens
• Long-term Regimens

• Harm due to lack of medical care
• Harm likely if no medical care
• Medical care that offers significant net benefit is not received

• Context (poverty, culture, religion)
• Family (disorganized, stressed)
• Parents (knowledge, understanding, motivation)
• Child (denial, chronic health problem)
• Disorder and Treatment (severity, chroncity, cost)
• Process of Care (relationship, communication)

• State the problem
• Convey interest in helping
• Begin with the least intrusive measures
• Address contributory factors
• -extra support
• -community resources
• -CPS

• Know the family: structure, needs, strengths
• Address risk factors: support, monitor, refer
• Address barriers to care
• Build on strengths
• Anticpatory guidance
• Health Education

• When actual or potential harm is serious or
• When less intrusive efforts have failed and actual or potential harm persist

• Make treatment practical
• --Simplify the regimen
• --prioritize treatments
• --provide cues and reminders
• Follow-up
• --telephone
• --in person: office, home
• Family issues
• --identify beliefs, skills, motivation
• --identify supports, stressors, barriers
• --involve key persons in treatment plan
• Communication
• --use appropriate language
• --give written instructions

• Sensitivity, humility, flexibility
• Weigh costs and benefits of your treatment
• Seek reasonable compromise
• Considre approaching group leaders
• Court interventions?

• Lack of supervision and careful monitoring
• Failure to remove hazards and avoid dangerous situations

• Kept from school to do work or babysitting
• Exaggerated illness

• Failure to provide regular, ample meals
• Failure to keep child clean
• Basic needs for clothing and shelter not met

• Failure to provide affection, attention
• Withdrawal
• Developmental delays
• Self-stimulating behaviors
• Insecure in play

• Economic
• Ecological
• Societal

• Is 44% higher in lower socioeconomic families
• A potential error is overzelousness in the detection of neglect, leading to the confusion of neglect with poverty or ignorance
• Only if improvished families refuse reasonable services to children should neglect be considered

• Poorly kept, unfriendly neighborhood
• Feel unsupported by their surroundings and develop low morale
• Social isolation
• Lack good knowledge about child rearing

• Welfare reform that decreases eligibility categories
• Lack of quality, affordable daycare services for working moms
• Lack of affordable housing
• Lack of health care insurance
• Journal of Pediatrics study found that neglectful moms were less likely to have completed high school; had more children younger than 6 years of age; scored poorer on parenting skills and support system scales
• Neglected children were lower in birth weight; rate more difficult tempermentally; poorer mental, motor, and developmental scores

• Fussier, more demanding, unsociable
• Less adaptive, more inconsolable
• Developmental lags (oral-motor skills, etc)

• Unusual beliefs about normal diet
• Distorted mother-child relationship
• Multiple problems
• Emotional deprivation

• Rejecting
• Terrorizing
• Ignoring
• Isolating
• Corrupting
• Exploiting

Refusing to show the child's worth; name calling, ignoring, etc

Threaten the child with a punishment; fear

Refuse to provide stimulation and praise that the child needs

Preventing them from opportunities of experiencing social needs

Teach the child anti-social, deviant behaviors

Using the child to satisfy adult needs; the child takes care of the adult

• Rejecting
• Terrorizing
• Ignoring
• Isolating
• Corrupting

• Do not know enough about child development to cope with the normal demands resulting from their child's behavior at different developmental stages
• Lower socioeconomic stauts that generates a sense of powerlessness and frustration
• Middle class families where there is stress, tension, and aggression coupled with inadequate parenting skills and unrealistic expectations
• Poorere coping skills, child management techniques, and more difficulty in forming relationships (don't know how to handle bumps in the road)

• Suffer feelings of being inadequate, isolated, unwanted, and unloved
• Low self-esteem
• May fight back with aggression or behavior problems
• May trun anger inward (self-destructive behaviors)
• Somatic complaints (can never focus on where the hurt is)
• Sleep disturbances
• Frightened, distressed, anxious

• Motivation to sexually abuse a child
• --emotional congruence
• --sexual arousal
• --blockage
• Overcoming internal inhibitors (this is a requirement for sexual abuse)
• Overcoming external inhibitors (supervision, family, peers, etc)
• Overcoming the resistance of the child

Why is a person not deterred by conventional social inhibitions from having a sexual relationships with a child?